Postpartum Depression Causes and Risk Factors

Hormones

While you’re pregnant, your levels of reproductive hormones (like estrogen and progesterone) are very high. But once you’ve delivered your baby, the level of these hormones suddenly drops. Research shows that the sudden change in levels contributes to postpartum depression.

This drop in reproductive hormones isn’t the only hormonal change that happens. After birth, your body revs up the production of lactogenic hormones to ensure a good supply of breast milk. In addition, thyroid hormone levels can drop sharply. This drop may lead to symptoms similar to those of depression.

Sleep deprivation

You’ve expended tremendous energy giving birth. Although you’d like nothing better than to catch up on your Zzz’s, your baby most probably won’t let you. Although newborns sleep between 14 to 17 hours in a 24-hour period, this doesn’t happen in one stretch.

Physical changes

Labor and delivery take their toll on your body, and it will take a few weeks (or more) to heal. It can be hard to accept your new body — or the fact that you need to take it easy for a while. This can affect your mental and emotional health.

Stress

Of course you’re grateful for your baby, but that doesn’t mean you don’t feel some stress. Or a lot of stress.

On top of feeling like you have no free time, you’ll likely also have to make some changes in your work and home routines and renegotiate your closest relationships. No wonder your emotions are heightened.

Anxiety

You may feel overwhelmed with the responsibility of caring for this tiny person. You may have doubts about your ability to be a good parent.

Keep pediatrician Donald Winnicott’s concept of a “good enough” parent in mind. Winnicott believed that the way to be a good parent is to be a good enough parent. Children need their parents to fail them in tiny, tolerable ways so that they can learn to cope and thrive.

Lack of support

Bringing new life into the world can be challenging. If you’re a single parent (and that wasn’t your desire or plan), or you lack nearby family and friends to lean on, you may feel overwhelmed.

Feeding

In addition to adjusting (and readjusting) to a new sleep schedule, establishing a successful breastfeeding or bottle-feeding routine can take some time. It can be overwhelming to realize that you’re now responsible for all of your baby’s nutritional needs.

Challenging temperament

Temperament means the way your baby reacts to the world. Some babies are just more easygoing than others. A baby with a difficult temperament is more sensitive to changes and has irregular habits and routines. This is common — but that doesn’t mean it’s not challenging.

While anyone can experience postpartum depression (even the non-birthing partner), there are certain risk factors.

A history of depression

A study of 10,000 mothers found that among those who screened positive for postpartum depression, 26.5 percent had noticed symptoms of depression before their pregnancy.

Johns Hopkins researchers also suggest that while 10 to 18 percent of all mothers are likely to develop postpartum depression, 30 to 35 percent of mothers with a previously diagnosed mood disorder are likely to develop the condition.

Increased stress

Giving birth involves many changes, and even positive changes can cause a certain amount of stress. However, if you’re already dealing with a stressful situation such as the following, you may have increased risk:

• low income
• lack of support
• serious health problems
• divorce or separation
• death
• multiple births

Genes

Research done by Johns Hopkins suggests that genes also play a part in PPD. (Note that the study was small and included pregnant people and mice.) Researchers think that estrogen brings about changes in certain cells in the hippocampus. This is the part of the brain that governs mood.

In addition, in some ways estrogen behaves like an antidepressant. The sudden drop in levels can adversely affect your mood.

Other risk factors

• your baby is preterm.
• you’re younger than 20 years old
• you have a history of alcohol or drug misuse

Postpartum depression can affect your general health and many areas of your life. A 2019 review of studies showed the following areas may be impacted by PPD:

• General health. Mothers with PPD scored lower on a health survey and consulted more often with family physicians than other mothers. (This does not mean consulting with your doctor is a bad thing — if you have concerns, you should!)
• Psychological health. Mothers with PPD reported being less happy than mothers without PPD. They had significantly higher levels of anger, lower scores for anger control, and lower scores for self-esteem.
• Relationships. Mothers with PPD had more relationship difficulties. They more often rated their sexual relationships as distant, cold, and difficult.
• Potential for addiction. PDD was associated with an increased risk of smoking and misuse of alcohol.

How PPD affects your baby

The review also showed how a baby’s physical and mental health may be affected by PPD:

• Physical health. Babies whose mothers had PPD had more colic. These babies also showed a stronger infant pain response during routine vaccinations. These babies had more night-time awakenings and problematic sleep patterns.
• Mental health. Babies whose mothers had PPD showed higher levels of fear and anxiety compared to other babies. At 2 years old, these children showed more behavioral disorders.

However, it’s hard to draw conclusions here. The patterns were observed by researchers, but we can’t be certain PPD directly caused the reactions — it could be that the colic or anxiety contributed to the parent developing PPD, for example. (Kind of like the age-old question of which came first, the chicken or the egg.)

Bonding

PPD can lead to less closeness, warmth, sensitivity, and emotional attachment between parent and baby. Parents with PPD may also be more likely to stop breastfeeding within the first few months.

How PPD affects your partner

If you have a partner, they may also be affected. In fact, between 4 and 25 percent of new non-birthing partners may show signs of PPD. Here’s what they may be feeling:

• Overwhelmed and frustrated. Your partner may be struggling to balance the extra demands at home with their usual schedule.
• Unappreciated. They may feel that you don’t appreciate their efforts.
• Anxious. They may be anxious about having lost the “former” you and fearful that things have changed irreversibly.

While 10 to 15 percent of birthing parents will have PPD after delivery, many more will experience mood swings or the baby blues in the short-term.

If you have the baby blues, you might feel overwhelmed, irritable, anxious, and moody. You might also have changes in your eating and sleeping patterns. While these symptoms sound like PPD, there are ways to tell them apart:

• Starting time. The baby blues set in at about 4 to 5 days after the birth of the baby, whereas PPD can set in much later.
• Duration The baby blues last about a week or two. PPD lasts for longer than 2 weeks. In 25 to 50 percent of people, it will last for longer than 7 months.

If your symptoms persist for longer than 2 weeks or become so intense that you can no longer care for yourself or your baby, speak with a doctor. They may recommend medication, therapy, or a support group.

If you’re having suicidal thoughts

If you’re having suicidal thoughts or fear that you may harm yourself or your baby, reach out for help immediately. Here are some people that you might contact:

• Call a family member, close friend, support group member, or spiritual leader.
• Call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to speak to a counselor.
• Call 911 or your local emergency services.
• Call your doctor.

If you suspect that you might have PPD, know that there’s light at the end of the tunnel. With the right treatment and support, you’ll get through this. You’re doing a good job.